File No.

1-0015
CIVIL AERONAUTICS BOARD

A I R C R A F T A C C I D E N T REPORT

ADOPTED: February 25, 1965 RELEASED: March 3, 1965

PAN AMERICAN WORLD AIRWAYS, I N C

BOEING 707-121, N709PA
I\SEAR ELKTON, MARYLAND
DECEDBER 8, 1963

SYNOPSIS

A Pan American World A i r w a y s , I n c . , Boeing 707-121, N709PA, F l i g h t 2 l 4 ,

c r a s h e d a t 2059 e . s . t . , December 8, 1963, n e a r E l k t o n , Maryland.

F l i g h t 214 was i n a h o l d i n g p a t t e r n a w a i t i n g a n i n s t r u m e n t approach t o

t h e P h i l a d e l p h i a I n t e r n a t i o n a l A i r p o r t when i t was s t r u c k by l i g h t n i n g .
Immediately t h e r e a f t e r , t h e a i r c r a f t was observed t o be on f i r e . A l a r g e por-
t i o n of t h e l e f t wing s e p a r a t e d i n f l i g h t and t h e a i r c r a f t crashed i n f l a m e s
a g p r o x i m a t e l y t e n n a u t i c a l miles southwest of t h e New Castle, Delaware VOR.
All p e r s o n s a b o a r d , 73 p a s s e n g e r s and e i g h t crew members, p e r i s h e d i n t h e
c r a s h and t h e a i r c r a f t was d e s t r o y e d .

The Board d e t e r m i n e s t h e p r o b a b l e cause of t h i s a c c i d e n t was l i g h t n i n g -

induced i g n i t i o n of t h e f u e l / a i r m i x t u r e i n t h e No. 1 r e s e r v e f u e l t a n k w i t h
r e s u l t a n t e x p l o s i v e d i s i n t e g r a t i o n of t h e l e f t o u t e r wing and loss of c o n t r o l .

Accident

Pan American F l i g h t 214, a Boeing 707-121, N709PA, d e p a r t e d F r i e n d s h i p

I n t e r n a t i o n a l A i r p o r t , B a l t i m o r e , Maryland, f o r P h i l a d e l p h i a , Pennsylvania, a t
2021, 1/ December 8, 1963. The a i r c r a f t , w i t h 73 p a s s e n g e r s and a crew of e i g h t ,
was o n a n Instrument F l i g h t Rules (IFR) c l e a r a n c e . F l i g h t 214 r e p o r t e d over
t h e New C a s t l e , Delaware VOR a t 2042 and was i n s t r u c t e d t o hold a t 5,000 f e e t ,
west of t h e VOR. A t 2058 a rWAYDAY" 2/ t r a n s m i s s i o n was heard from t h e f l i g h t .
S h o r t l y t h e r e a f t e r , t h e p i l o t of a n o t h e r a i r c r a f t b r o a d c a s t e d t h a t " C l i p p e r 214.
i s going down i n

F l i g h t 214 crashed two m i l e s e a s t of E l k t o n , Maryland, a t 2059. All p e r -

s o n s aboard t h e a i r c r a f t were k i l l e d i n s t a n t l y . The a i r c r a f t was d e s t r o y e d by
e x p l o s i o n , impact, and f i r e .

J
l A l l t i m e s h e r e i n a r e e a s t e r n s t a n d a r d based on t h e 24-hour c l o c k ,

-2/ A radio c a l l signifying an aircraft i n distress.

 O i l t h e morriirig 01' December 8, 1963, N709PA d e p a r t e d P h i l a d e l p h i a , Periris.ylv:irii:L,
a s Pari Americari P'ligiit, 213 arid proceeded t o Sari Juarl, P u e r t o Hico, w i t h a n en
r o u t e s t o p a t B a l t i m o r e , Maryland. The a i r c r a f ' t a r r i v e d a t San Juan w i t h 25,500
pourids of f u e l 3/ renitlinicg aboard. The a i r c r a f t was f u e l e d with Type B t o a
t o t a l of 78,000-pounds. The r e s u l t a n t f u e l l o a d was a mixture oi' Type A and Type
B d i s t r i b u t e d as f o l l o w s : Nos. 1 and 4 main and r e s e r v e t a n k s 69 p e r c e n t Type B ;
Nos. 2 :ind 3 t a n k s 03.5 p e r c e n t Type B ; c e n t e r t a n k 100 p e r c e n t Type B .

P r i o r t o d e p a r t u r e i'rom San Juan t h e c a p t a i n of F l i g h t Zl4 was b r i e f e d or1

t h e wekther a l o n g h i s int,ended r o u t e t o P h i l a d e l p h i a . T h i s b r i e f ' i n g i n c l u d e d
a d i s c u s s i o n of SIGNET No. 3 4/ r e l a t i v e t o p o s s i b l e t h u n d e r s t o r m a c t i v i t y , arid
t u r b u l e n c e . The t i m e s of' f r o n t a l p a s s a g e a t c e r t a i n east, coast, c i t i e s i n e l d i n g
B a l t i m o r e and P h i l d e l p h i a were a l s o d i s c u s s e d . The c a p t a i n was a l s o p r o v i d e d w i t h
ci " f l i g h t , f o l d e r " which c c n t a i n e d t h e r e q u i r e d weather documents.

N709PA l e 3 Sari J u a n :is Pan American F l i g h t 214 a t 1610 and a r r i v e d a t B a l t i -

more a t 193. No maintenance d i s c r e p a n c i e s were r e p o r t e d by t h e creinl a t B a l t i m o r e ,
A v i s u a l i n s p e c t i o n of t h e a i r c r a f t , i n c l u d i n g examination f o r f u e l l e a k s , was
perfoi>med by a P a n American mechanic, w h i l e t h e a i r c r a f t was b e i n g r e f u e l e d , and
n o d i s c r e p a n c i e s were rioted. 27,400 pounds of' Type A were added a t B a l t i m o r e r e -
s u l t i n g i n t h e f o l l o w i n g q u a n t i t i e s and m i x t u r e s : Nos. 1 and 4 r e s e r v e t a n k s
a n e s t i m a t e d 1.81 g a l l o n s of' r e s i d u a l f u e l , a p p r o x i m a t e l y 69 p e r c e n t Type B ; Nos.
1 and 4 main taiiks 12,000 pounds of f u e l each, 31 p e r c e n t Type B ; c e n t e r t a n k ,
e s i i m a t e d 15.05 galloris r e s i d u a l f u e l , 100 p e r c e n t Type B . F u e l t e m p e r a t u r e s
were e s t i m a t e d t o be 4 2 O F i n t h e r e s e r v e t a n k s and 4 6 O F i n t h e mains. A f t e r t h e
a 2 c i d e r . t f u e l samples were t a k e n from t h e supply s o u r c e s a t I d e l w i l d , B a l t i m o r e ,
arld Sar; Juan. A n a l y s i s oi' t h e s e sampl2s r e v e a l e d no d i s c r e p a n c i e s .

A t B a l t i m o r e a Pan American o p e r a t i o n s r e p r e s e n t a t i v e t a l k e d t o t h e c a p t a i n
a b o u t t h e weather between B a l t i m o r e and P h i l a d e l p h i a . He provided t h e c a p t a i n w i t h
c o p i e s of t h e 1900 east c o a s t weather sequence r e p o r t s . The o p e r a t i o n s r e p r e s e n t a t -
t i v e t o l d t h e c a p t a i r i t h a t t h e front passed B a l t i m o r c I!... a l i t t l e w h i l e ago ...I1
.
and would b e i n P h i l a d e l p h i a I T . . about, 01252 (2025) . I t

F l i g h t 214 depart,ed B a l t i m o r e a t 2024 c l e a r e d IFR t o t h e P o r t Herman I n t e r -

s e c t i o n v i a V i c t o r 44 ( a i r w a y ) , V i c t o r 4 3 3 , a t 4,000 f e e t , t o e x p e c t f u r t h e r c l e k r -
ance a f t e r P o r t H e r m s r i v i a V i c t o r 433 t o t h e N e w Castle VOR t h e n c e d i r e c t t o P n i l a -
delphia.

A f t e r ttikeoi'f', Hciltbiore D e p a r t u r e C o n t r o l p r o v i d e d r a d a r v e c t o r s t o Victor. &!+

where a i r t r a f f i c "coriL,rollt was t r a n s f e r r e d t o New C a s t l e Approach C o n t r o l . The
B a l t i m o r e r a d a r m o n i t o r i n g of t h e d e p a r t u r e r e v e a l e d n e i t h e r unusual f l i g h t p r o g r e s s

3/ Type A i s a kerosene t y p e t u r b i n e f u e l w i t h a f l a s h p o i n t OS 110' - 15O0F.

Type i s a wide-cut g s s o l i n e t y p e t u r b i n e f u e l w i t h 2n u n s p e c i f i e d f l a s h p o i n t
and a maximum F.eia vapor p r e s s u r e of 3 p . s . i .

41/ A m e t e o r o l o g i c 2 1 message d e s i g n e d p r i m a r i l y f o r a i r c r a f t i n f l i g h t wzrn-

i n g of weather c o n d i t i o n s p o t e n t i a l l y hazardous t o t r s n s p o r t c a t e g o r y and o t h e r
t y p e s of a i r c r a f t . SIGMET No. 3 was i s s u e d by t h e USWE3 o f f i c e , Washington Ntttiorid
Airport.
 -3-
tior s i g r i i f ' i c a n t weat,her. Radar s e r v i c e was t e r m i n a t e d e i g h t miles west of t h e
Rock h11 Int,ersect,ion a t 2031.

Commuri i c a t i o n was e s t a b l i s h e d between F l i g h t 214 and New C a s t l e Approach

Control, which had no r a d a r , The f l i g h t was c l e a r e d t o climb t o 5,000 f e e t and
r e c l e a r e d t o t h e N e w Castle VOR. F l i g h t 214 r e p o r t e d over t h e New C a s t l e VOR a t
2042, 5,000 f'eet, and c o n t r o l was t h e n t r a n s f e r r e d t o P h i l a d e l p h i a Approach C o n t r o l
wh;.ch provided t h e crew w i t h t h e f o l l o w i n g :

It... P h i l a d e l p h i a weather, now, seven hundred s c a t t e r e d ,

measured e i g h t hundred broken, one thousand o v e r c a s t ,
s i x miles ( v i s i b i l i t y ) w i t h r a i n shower, a l t i m e t e r two
n i n e f o u r f i v e , t h e s u r f a c e wind i s two hundred and e i g h t y
d e g r e e s a t twenty ( k n o t s ) w i t h g u s t s t o t h i r t y ( k n o t s ) .
I ' v e g o t f i v e a i r c r a f t , have e l e c t e d t o hold u n t i l t h i s ...
extreme winds have p a s s e d , ... do you wish t o b e c l e a r e d
f o r a n approach or would you l i k e t o hold u n t i l t h e s q u a l l
line . .. p a s s e s P h i l a d e l p h i a , over?11

Tne crew a d v i s e d P h i l a d e l p h i a they would hold and were i n s t r u c t e d t o h o l d west

of New C a s t l e VOR on t h e 270 r a d i a l and g i v e n a n expected approach c l e a r a n c e t i m e
of 2110. The crew r e q u e s t e d and r e c e i v e d p e r m i s s i o n t o use two minute l e g s i n
t h e h o l d i n g p a t t e r n . A t 2050:&5 t h e crew a d v i s e d P h i l a d e l p h i a t h e y were ready t o
start a n approach. They were t o l d t o c o n t i n u e t o h o l d and t h e y would be c l e a r e d as
soon as p o s s i b l e . The crew acknowledged w i t h "Roger, no h u r r y , j u s t wanted you
t o know t h a t ... w e ' l l a c c e p t a c l e a r a n c e . " Approximately e i g h t m i n u t e s l a t e r , a t
2058:56 t h e f o l l o w i n g t r a n s m i s s i o n was heard on t h e P h i l a d e l p h i a Approach C o n t r o l
frequency 124.6 "MAYDAY MAYDAY MAYDAY" 2/ C l i p p e r 214 o u t of c o n t r o l . Here we go."
Seconds l a t e r a n o t h e r t r a n s m i s s i o n on t h e same frequency was heard l l C l i p p e r 214
i s going down i n flames.I1 T h i s l a t t e r t r a n s m i s s i o n was made by t h e f i r s t o f f i c e r
of N a t i o n a l A i r l i n e s F l i g h t 16 (NAL 16). 6/ NAL 16 was i n t h e same h o l d i n g p a t t e r n
as F l i g h t 214 b u t 1,000 f e e t h i g h e r , and t h e f i r s t o f f i c e r had seen t h e Pan American
f l i g h t descending on f i r e .

The a i r c r a f t c r a s h e d a t 2059 i n open c o u n t r y e a s t of E l k t o n , Maryland. Witness-

e s i n t h e a c c i d e n t a r e a d e s c r i b e d t h e weather as cloudy, w i t h l i g h t r a i n f a l l i n g ,
and l i g h t n i n g .

Turbulence, thunderstorms, and i c i n g were i n c l u d e d i n a l l r o u t i n e f o r e c a s t s

as w e l l as SIGMETS f o r t h e area surrounding t h e z c c i d e n t s i t e d u r i n g t h e p e r i o d
F l i g h t 214 was t o b e o p e r a t i n g i n t h a t r e g i o n .

The weather a t Wilmington, Delaware, n i n e n a u t i c a l miles e a s t of t h e a c c i d e n t ,

was r e p o r t e d , a t 2100, t o be:

5/ T h i s p o r t i o n of t h e r e c o r d i n g i s not e n t i r e l y c l e a r , b u t t h i s r e p r e s e n t s
t h e b e s t i n t e r p r e t a t i o n p o s s i b l e due t o t h e q u a l i t y of t h e t a p e .

-6/ NAL F l i g h t 16 was a Douglas DC-8, N875C.

 -4.-
900 s c a t t e r e d , measured 4.400 o v e r c a s t , v i s i b l i t y 8 m i l e s , thunder-
storm, l i g h t r a i n , t e m p e r a t u r e 4.4,dew point 43, wind west-southwest
10 k n o t s , thunderstorm began a t 2054, thunderstorm west, movement
unknown, l i g h t n i n g i n cloud, cloud t o ground west-northwest -
.
n o r t hw e st

The Wilmington 2000 r e p o r t had i n d i c a t e d a f r o n t a l passage a t 1931.

The weather i n t h e h o l d i n g p a t t e r n area as d e s c r i b e d by t h e f i r s t o f f i c e r of

F l i g h t 16 was cloudy, w i t h comparatively smooth a i r , and t h e ground l i g h t s were
o c c a s i o n a l l y v i s i b l e through b r e a k s i n t h e clouds. The crew of t h i s f l i g h t ob-
served a l i g h t n i n g s t r i k e on t h e i r a i r c r a f t w h i l e i n t h e h o l d i n g p a t t e r n . L a t e r
examination of t h e a i r c r a f t r e v e a l e d evidence of l i g h t n i n g damage t o t h e l e f t wing
t i p and t h e empennage.

O f t h e 14.0 ground w i t n e s s e s i n t e r v i e w e d , 99 r e p o r t e d s i g h t i n g an a i r c r a f t o r
f l a m i n g objec-t i n t h e sky. Seventy-two of t h e s e w i t n e s s e s saw l i g h t n i n g and seven
s t a t e d they saw t h e l i g h t n i n g s t r i k e t h e a i r c r a f t . Three o t h e r p e r s o n s saw a b a l l
of f i r e appear a t t h e f o r k o r one end of t h e l i g h t n i n g s t r o k e . Seventy-two w i t n e s s e s
i n d i c a t e d t h a t t h e b a l l of f i r e appeared c o n c u r r e n t w i t h or immediately f o l l o w i n g
t h e l i g h t n i n g s t r o k e . Twenty-seven saw f i r e preceded by l i g h t n i n g w i t h a v e r y s h o r t
i n t e r v a l b e f o r e t h e f i r e was v i s i b l e . Twenty-three w i t n e s s e s observed a n e x p l o s i o n
i n c o n n e c t i o n w i t h t h e a i r c r a f t i n f l i g h t a f t e r f i r e was observed. T h i r t y - e i g h t
mentioned a n e x p l o s i o n a t impact.

Addit:i.onally, 28 w i t n e s s e s saw o b j e c t s f a l l from t h e a i r c r a f t i n f l i g h t and

48 d e s c r i b e d v a r i o u s p o r t i o n s of t h e a i r c r a f t t h e y observed t o be i n flames.
Nearly 600 p i e c e s of wreckage were strewn o u t s i d e t h e main impact c r a t e r i n
a n a r e a approximately f o u r m i l e s l o n g and one m i l e wide. The l o n g axis of t h i s
a r e a was on a b e a r i n g of 255 d e g r e e s t r u e from t h e e a s t e r l y end through t h e impact
c r a t e r n e a r t h e w e s t e r l y end. However, t h e r e were two d i s t i n c t wreckage p a t h s
and t h r e e c o n c e n t r a t i o n s i n t h i s area.

One of t h e s e was a s t r a i g h t p a t h about 1,500 f e e t wide and two miles long.

I t i n c l u d e d t h e wreckage f a r t h e s t from t h e main c r a t e r and c o n s i s t e d of n e a r l y
a l l p i e c e s of t h e l e f t o u t e r wing p a n e l , n o t a b l e e x c e p t i o n s b e i n g t h e inboard por-
t i o n s of t h e o u t e r p a n e l r e a r s p a r and a i l e r o n . The b e a r i n g of t h i s p a t h was 250
d e g r e e s from i t s e a s t e r l y end toward t h e impact c r a t e r ; however, w e s t e r l y exten-
s i o n of t h e p a t h c e n t e r l i n e passed approximately 2,500 f e e t s o u t h of t h e c r a t e r .
The f a r t h e s t p i e c e of wreckage was approximately 19,600 f e e t and t h e n e a r e s t i n
t h i s p a t h 8,200 f e e t from t h e main impact c r a t e r . The d e n s i t y of t h e s e p i e c e s
v a r i e d from low t o h i g h p r o g r e s s i n g w e s t e r l y a l o n g t h e 250-degree p a t h .

Nearly a l l of t h e remaining s c a t t e r e d wreckage was s t r u n g n u t a l o n g a s l i g h t l y

curved p a t h w i t h a width of about 600 f e e t n e a r t h e c r a t e r and a t r a c k of about 220
d e g r e e s t o t h e c r a t e r i n t h i s a r e a . Continuing e a s t e r l y t h e p a t h , except f o r a
c o n c e n t r a t i o n of f i v e p i e c e s of wreckage about 4,500 f e e t e a s t - n o r t h e a s t of t h e
c r a t e r d i d n o t exceed 1,000 f e e t i n width w i t h i n 11,000 f e e t of t h e c r a t e r , a t which
p o i n t i t s t r a c k was about 255 d e g r e e s . A t 16,000 f e e t from t h e c r a t e r i t was approx-
i m a t e l y 2,200 f e e t wide and i t s t r a c t was about 270 d e g r e e s . The most e a s t e r l y
piccat. 01’ wtsc:,Bk:ige l’ourid alorig t h i s p a t h was approximately 17,400 f e e t from t h e
<)L,,
i ’ ~ d : ~ I All pieces i’rwm t h e r e a l o n g t h i s p a t h t,o about, 7,500 f’eel, f‘rom t h e crat,er
w c ~ t * c :vui..y l o w in derisj L y , c o n s i s t i n g of items such as Seat, Occiipied c a r d s , c a b i n
. L I I , Y .iii*L,oiidi i, ioriirig irisul;iLion, f‘ragments of’ t h i n s k i n a s t , r i n g e r s , e t c . Tn a n
: L I Y L ~ :thou t, 1,600 I’eet, loiig, c e n t e r e d approximately 4,300 feet, f’rom t h e impacl, m a -
l e r , Ltie wreckage c o n s i s t e d mainly of more dense p i e c e s , s u c h a s c e n t e r s e c t i o n
i’uel c e l l biLgs and backilig s t z i p s , h o r i z o n t a l t a i l l e a d i r l g edge d e i c e r s t r i p s , e t c .
Nc:Lrer* Lo a t i d s t , i l l n o r L h e a s t of t h e c r a t e r t h e r e were numerous p i e c e s of s t i l l
d e n s e r wreckage, such as f‘ragments of‘ wing s t r u c t u r e surroundirlg Lhe c e n t e r s e c t i o n
i ’ u s l t.arik, air cotidit, ioning packs i n c l u d i n g t,he primary h e a t exchangers, t h e r i g h t
i i o r i z o n t n l s l a b i l i z e r , e t c . Within a r a d i u s of 360 f e e t from t h e main impact c r a t e r
t h e r e were numerous p i e c e s of dense wreckage i n c l u d i n g p a r t s of t h e r i g h t wing and
i’uselage, r i g h t main l a n d i n g g e a r , h o r i z o n t a l and v e r t i c a l t a i l s u r f a c e s and t h e
Nos. 2 and 3 e n g i n e s and pods. The c r a t e r c o n t a i n e d most of t h e f u s e l a g e and l e f t
inlier wing wreckage, the l e f t main g e a r and t h e nose g e a r ,

In two small wi*eckage c o n q e n t r a t i o n s s e p a r a t e from t h e two p r e v i o u s l y mentioned

p a t h s , t h e r e were t e n p i e c e s , c o n s i s t i n g of t h e Nos. 1 and 4 e n g i n e s , p y l o n s s n d
s e c t i o r i s of t h e i r cowling. The No. 1 engine and pylon assembly was approximately
1,440 f e e t on a b e a r i n g of 25 d e g r e e s and t h e No. 4 engine and pylon assembly approx-
i m a t e l y 1,925 f e e t on a b e a r i n g of 13 d e g r e e s from t h e impact c r a t e r . None of t h e
o t h e r e i g h t p i e c e s w a s more t h a n 165 f e e t from t h e corresponding engine.

Examination of ttie wreckage i n c o n j u n c t i o n w i t h c o n s i d e r a t i o n of t h e wreckage

d i s t r i b u t i o n d i s c l o s e d m u l t i p l e i n d i c a t i o n s of l i g h t n i n g damage, f i r e and d i s i n t e -
g r a t i o n i n f l i g h t , which w i l l be d i s c u s s e d i n f o l l o w i n g paragraphs. However, t h e
f o u r powerplant pods i n t h e i r e n t i r e t y y i e l d e d only evidence of t h e i r having s e p a r a -
t e d from t h e a i r c r a f t , i n f l i g h t due t o e x c e s s i v e l o a d f a c t o r s , without e n g i n e f a i l u r e
or m a l f u n c t i o n p r i o r t o s e p a r a t i o n .

A m a j o r i t y of t h e components of t h e v a r i o u s systems w i t h i n N799PA were d e s t r o y e d .

The recovered p o r t i o n s of t h e h y d r a u l i c and e l e c t r i c a l s y s t e m s showed no evidence of
o p e r a t i o n a l d i s t r e s s or pre-impact f a i l u r e . The f u e l dump v a l v e s were determined t o
be i n t h e “closed” p o s i t i o n .

A p o r t i o n of t h e t r a i l i n g edge of t h e l e f t h o r i z o n t a l s t a b i l i z e r was burned

through and t h e p a i n t was b l i s t e r e d a l o n g t h e e n t i r e upper and lower s u r f a c e s of
t h e t r a i l i n g edge. There was molten aluminum a l l o y s p l a t t e r e d on t h e forward upper
s u r f a c e of t h e l e a d i n g edge of t h e s t a b i l i z e r which was determined t o have been de-
p o s i t e d i n f l i g h t . There was no evidence of f i r e damage on t h e r i g h t h o r i z o n t a l
s t a b i l i z e r . The l e f t s i d e of t h e v e r t i c a l t a i l ar,d a f t f u s e l a g e were e x t e n s i v e l y
scorched by exposure Lo f i r e i n f l i g h t . Numerous i n s t a n c e s of i n - f l i g h t f i r e were
found on t h e recovered wreckage of t h e l e f t inboard wing a f t of t h e r e a r s p a r , a l -
though most of Lhe e x t e r n a l s k i n remained u n i d e n t i f i e d . I n - f l i g h t f i r e damage was
noted on t h e t h r e e s t e e l t r a c k s f o r t h e inboard f l a p and on t h e t r a c k a t t h e inboard
end of t h e outboard f l a p , t h e i n n e r end of t h e outboard f l a p , fragments of t h e s p o i l -
e r s , dump c h u t e components, cove l i p d o o r s , and fragments of t h e f o r e f l a p s .

The h i g h frequency (HF) r a d i o a n t e n n a had s e p a r a t e d from t h e v e r t i c a l t a i l s e c -

t i o n and e x h i b i t e d numerous t i n y pock marks which were d u l l i n appearance.

The complete l e f t wing t i p , w i t h p o r t i o n s of t h e l e f t o u t e r a i l e r o n and s p a r

webs s t i l l a t t a c h e d , was found approximately 1.8 m i l e s e a s t - n o r t h e a s t of t h e main
 - 6 -

irriprict, re:^.. M u l t iplc l i g h t r i i r i g - s t r i k e m i r k s were f'ound 011 Lhe left, wing t i p .

'Tliere W L ~ Q a n aL*ea of' exLcnsive damage on t h e t o p s u r f a c e of' t h e t i p a l o n g tkie cnd
iaib, i n and :adj:icenl, I c t,he joint, where t h e wing Lip c a p arid t,he Lop wing $ k i n
W ~ L ' I : at tached to Liie end r i b . The damaged a r e a extended from t,he t r a i l i n g edge 01'
tlie wirig t o it p o i n t a b o u t t h r e e f e e t e i g h t i n c h e s from t h e l e a d i n g edge, measilir'ed
L ~ ( ig i he erid r i b . Within t h i s area t h e r e were numerous spoLs where t h e m e t a l z i x -
X

l'ace a d r l v e t heads showed i n d i c a t i o n s of m e l t i n g , and a s s o c i a t e d dendrit, i c p;iLLerrls

were v i s i b l e on t h e wing surface. The l a r g e s t s i n g l e i n d i c a t i o n of l i g h t n i r g d3mage
was x i i r r e g u l a r shaped h o l e a b o u t 1-8 i n c h e s i n d i a m e t e r . There was e v i d e n c e of' high1
t i t > a \ i t 1 t h i s a r e a and f u s e d m e t a l was found around t h e h o l e . A smaller h o l e was
b u r n e d a d j a c e n t t o t h e outboard edge o f t h e a c c e s s c o v e r o v e r t h e f l u x g a t e compass
t m i i s m i t t e r . Four r i v e t heads and smll areas of metal a d j a c e n t t o t h e r i v e t s were
burned o f f t h c t o p s u r f a c e n e a r t h e t r a i l i n g edge of t h e wing t i p . Numerous small
l u s t r o u s c r a t e r s were found i n t h e wing t i p c a p r a n g i n g i n d i a m e t e r from 1/16 t o
1/8 inch. The d e p t h of t h e craters ranged from 1/32 i n c h L O complete p e r f o r a t i o n
of the 1/16 i n c h t h i z k wing t i p s k i n . Evidence o f f u s i o n was found a t t h e edges
of' two d r i l l e d h o l e s i n t h e wing t i p c a p and one of' t h e s e h o l e s had been e n l a r g e d
by me1;ing around t h e p e r l p h e r y . A darkened a r e a was found on t h e end r i b d i r e c t l y
opposi;e one h o l e . The p a i n t had been d i s c o l o r e d by h e a t and t h e r e was l o c a l i z e d
c h a r r i n g of t h e p a i n t . A few small s p e c k s of f u s e d metal were found on the p a i i i i .
There w a s no e v i d e n c e of' p i t t i n g i n t h e metal s u r f a c e of t h e r i b . The l i g h t r i i r g
ci:imge l i e a r e s t t h e f u e l t a n k v e n t o u t l e t i n t h e bottom of t h e l e f t wing was Ilk
i n c h e s from Lhe eage o r t h e v e n t o u t l e t . M e t a l l o g r a p h i c examiriation of s e v e n 1
'ireas oi' l i g h t n i n g damage showed c h a r a c t e r i s t i c d e p o s i t s of porous f u s e d metal CL
t h e ciamged s u r f a c e s arid a d i s t i n c t boundary between t h e a f f e c t e d and u n a f f e c t e d
mexl.
The s u r g e t a n k b o 7/r was i n t a c t e x c e p t f o r a 2.2 i n c h opening a l o n g t h e t o p ex-
t e n d i n g f r o m s p a r t o s p a r . T h i s opening encompassed t h e s u r g e t a n k end of' t h e v e n t
p a s s a g e s i'rom t h e f u e l t a n k s . The ends of t h e f r a c t u r e c u r l e d up and were moder-
a t e l y s o o t e d . The bottom s u r g e Lank s k i n was c u r l e d downward a t a f r a c t u r e l i n e
a l o n g t h e tank end c l o s u r e r i b . Very s l i g h t outward b u l g i n g of t h e t a n k e d r i b
was n o t e d . The i n t e r i o r of t h e s u r g e t a n k was h e a v i l y s o o t e d OA all s i d e s and t h e
se:ilant was burned i i i s i d e .

'The e x t e r i o r of t h e wing f u e l t a n k ram v e n t was moderately s o o t e d i n b o a r d o f

t,he r e c e s s i n t h e bottom s k i n . The h e a v i e s t c o n c e n t r a t i o n o f s o o t was below and
a f i of t h e t a c k v e n t s c r e e n . There was evidence of h e a t i n t h e i n l e t of t h e r a m
a i r v e n t scoop.

The wire bundle f o r t h e f l u x g a t e compass t r a n s m i t t e r skowed s i g n s of h e a t

damage and c h a r r i n g of t h e i n s u l a t i o n of' one wire. T h i s w i r e bundle was l o c a t e d
i n t h e s u r g e i m k d u c t i n g a r e a . Disassembly of t h e s u r g e tarik d u c t i n g r e v e a l e d
l i g h t s o o t i n g on t h e j - n t e r i o r wall and h e a v i e r s o o t i n g on t h e ouLside s u r f a c e of
t h e duct.

A 27-inch s e c t i o n of t h e forward s p a r was bulged outward and t h e bottom s p a r

c a p was bulged downward. There was s l i g h t s o o t i n g o r d i s c o l o r a t i o n on t h e r e s e r v e
t a n k s i d e of t h e s p a r and s l i g h t c h a r r i n g o f t h e s e a l a n t at t h e j u n c t u r e o f t h e
s p a r and t h e c l o s u r e r i b .

-7/ See a t t a c h m e n t N o . l., a schematic of t h e B-707 fuel. system.

 - 7 -

The c e t i t e r t a i i k bottom s k i n was s e p a r a t e d i n t h r e e p i e c e s . S t i f f e n e r s

atid a c c e s s d o o r s were bowed outward. The l a r g e s t s e c t i o n was bowed chordwise i n
:LII outward d i r e c t i o n . There were no s i g n s of f i r e damage.

There was c o n s i d e r a b l e ground-fire damage t o t h e r i g h t i n n e r wing.

The l e f t outboard f l a p and s p o i l e r s k i n were h e a v i l y sooted underneath caked

mud. There was a l s o s o o t under t h e mud on t h e inboard f l a p g e a r box area. The
l e f t i n b o a r d f l a p s showed evidence of f i r e damage. Measurement of t h e jackscrews
i n d i c a t e d t h e l e f t wing f l a p s were up. The r i g h t outboard f l a p showed heavy f i r e
damage and t h e bottom s k i n was burned away. These f l a p s were extended 1$ t o 2&
degrees .
The a i l e r o n s and s p o i l e r s on b o t h s i d e s , except t h e o u t e r h a l f of t h e l e f t
outboard a i l e r o n , e x h i b i t e d evidence of i n - f l i g h t f i r e .

The a i l e r o n and r u d d e r trim were n e u t r a l and t h e s t a b i l i z e r was trimmed f o r

0.8 d e g r e e s noseup.

The recovered wing and t a i l components were l a i d o u t i n t h e i r r e s p e c t i v e p o s i -

t i o n s f o r study of f i r e damage and t h e l e f t wing t i p and outboard s e c t i o n s were ex-
amined for evidence of l i g h t n i n g damage.

E l e c t r i c a l r e s i s t a n c e measurements were t a k e n a c r o s s 2 1 f u e l t a n k a c c e s s
p l a t e s . Readings o b t a i n e d v a r i e d from 0.0000 ohms t o 250,000 ohms. The h i g h e r
r e a d i n g s were o b t a i n e d where bondings had been broken.

A magnetic s t r e n g t h survey 2/ was made of t h e s t e e l components of t h e l e f t

and r i g h t wings, c e n t e r f u e l t a n k , and t h e h o r i z o n t a l and v e r t i c a l t a i l s e c t i o n s .
The r e a d i n g s ranged from l i g h t t o moderate w i t h o c c a s i o n a l areas of heavy magnetism.

S i m i l a r s u r v e y s were conducted on a USAF B-707-100 and a Pan American B-707-139

w i t h 3,454 and 10,530 h o u r s f l i g h t time, r e s p e c t i v e l y . The r e s u l t s were g e n e r a l l y
similar except t h a t t h e r e a d i n g s on t h e a f t end screws on t h e f u e l t a n k a c c e s s
p l a t e of t h e l e f t wing were h i g h e r on N7G9PA t h a n on t h e two t e s t e d a i r c r a f t . T h i s
work was a n a t t e m p t t o d e l i n e a t e t h e p a t h of t h e l i g h t n i n g - i n d u c e d c u r r e n t through
t h e wing s t r c u t u r e . D e s p i t e t h e one v a r i a t i o n i n r e s u l t s of t h e t h r e e magnetic s u r -
v e y s , no i n f o r m a t i o n s i g n i f i c a n t t o t h e i n v e s t i g a t i o n was o b t a i n e d .

The l e f t o u t e r wing and o t h e r p a r t s were examined and analyzed by t h e N a t i o n a l

Bureau of S t a n d a r d s (NBS) i n an e f f o r t t o d e t e c t i g n i t i o n p o i n t s and confirm l i g h t -
n i n g damage. S p e c i a l a t t e n t i o n was g i v e n t o t h e l e f t wing t i p and p a r t s of t h e
No. 1 r e s e r v e t a n k ; t h e l e f t f u e l v e n t s u r g e t a n k ; t h e HF a n t e n n a probe c o v e r ; a
p i e c e of t o p s k i n from t h e r i g h t s i d e of t h e c e n t e r f u e l t a n k w i t h f l o a t v a l v e
a t t a c h e d ; and t h e f l o a t v a l v e from t h e r i g h t wing r e s e r v e t a n k .

L i g h t n i n g d i s c h a r g e s can be hazardous t o a i r c r a f t f u e l systems by p o s s i b l y

i g n i t i n g t h e f u e l vapor w i t h i n t h e t a n k s . D i r e c t s t r o k e s may p e n e t r a t e t h e wall of

8/ See a t t a c h m e n t No. 1
-9/ Magnetic s t r e n g t h s u r v e y s were made using a comparative Gaussmeter w i t h a
probe c o n t a i n i n g f e r r o u s c o r e c o i l s , c u r r e n t a m p l i f i e r , microammeter, and s e n s i -
t i v i t y adjustment. Movement of t h e probe a c r o s s p a r t s checked induced v o l t a g e s
i n t o probe c o i l s and r e s u l t s were shown i n micro amperes.
 - 8 -
t h e t a n k o r cause i n t e r n a l s p a r k i n g , e i t h e r from t h e h i g h r e s i s t i v e and/or i n d u c t i v e
v o l t a g e s developed a c r o s s i n t e r n a l d i s c o n t i n u i t i e s , or from p o s s i b l y high v o l t a g e s
induced i n t h e f u e l probe w i r i n g . I n a d d i t i o n , flame can propagate through t h e
vent, system, I'rom i'uel vapors i g n i t e d a t t h e vent o u t l e t by d i r e c t s t r o k e s , stream-
e r i n g , o r b l a s t p r e s s u r e waves, s p a r k showers, and p o s s i b l e plasma p e n e t r a t i o n from
d i r e c t s t r o k e s . A c c e l e r a t e d s t u d i e s have r e c e n t l y been completed i n t o t h e s e h a z a r d s
t o provide t e c h n i c a l data on t h e i r p r o b a b l e occurrence and c o n t r o l . These s t u d i e s
have a l s o i n d i c a t e d t h e s t r u c t u r a l damage t h a t would b e caused by t h e d i f f e r e n t
c a u s e s of i g n i t i o n . N e i t h e r b l a s t wave compression nor induced s t r e a m e r i g n i t i o n
would l e a v e v i s i b l e evidence of t h e cause of i g n i t i o n . The v a r i o u s t y p e s of spark-
i n g could a l s o cause i g n i t i o n without l e a v i n g i d e n t i f i a b l e evidence b u t might l e a v e
such evidence i f t h e s p a r k i n g energy i s s u f f i c i e n t l y h i g h t o produce v i s i b l e p i t t i n g
or f u s i o n of m e t a l s u r f a c e s .

Tne l i g h t n i n g damage p r e v i o u s l y d i s c u s s e d was re-examined and confirmed. The

d e t a i l e d examination of s u r f a c e s , j o i n t s , r i v e t s , screws, f i t t i n g s , and f u e l q u a n t i t y
p r o b e s f o r p h y s i c a l evidence of i g n i t i o n - p r o d u c i n g s p a r k s where i g n i t a b l e f ueJ./air
m i x t u r e s may normally be p r e s e n t d i s c l o s e d no i d e n t i f i a b l e evidence of e l e c t r i c a l
a r c i n g . Thus, t h e a c t u a l mechanics of i g n i t i o n of t h e l e f t r e s e r v e t a n k c o n t e n t s
was not determined.

M e t a l s p l a t t e r s on t h e l e a d i n g edge of t h e h o r i z o n t a l s t a b i l i z e r were i d e n t i -
f i e d by s p e c t x o g r a p h i c a n a l y s i s as b e i n g formed from two d i f f e r e n t aluminum a l l o y s .
However, t h e s e a l l o y s could not be i d e n t i f i e d s i n c e t h e chemical composition of t h e
d e p o s i t s d i d not conform t o any a l l o y used i n t h e a i r p l a n e . The l o n g a x i s of t h e
d e p o s i t s v a r i e d from 18 d e g r e e s inboard t o 4 d e g r e e s outboard.

The a i r c r a f t r e c o r d s review i n d i c a t e d t h a t N709PA was maintained i n accordance

w i t h FAA and approved P a n American d i r e c t i v e s and procedures p r i o r t o t h e a c c i d e n t . .
These r e c o r d s r e v e a l e d no h i s t o r y of f u e l l e a k s , l i g h t n i n g s t r i k e s , o r s t a t i c d i s -
charges.

The f l i g h t r e c o r d e r t a p e was t o r n and crumpled b u t had l i t t l e f i r e damage.

Approximately 95 p e r c e n t of t h e t a p e was reassembled and r e a d o u t . The t a p e showed
a n e l a p s e d t - b e of approximately 32 minutes and 50 seconds from l i f t - o f f a t Baltimore
u n t i l impact w i t h t h e ground. The r e c o r d of t h e f i r s t 32 minutes of f l i g h t was
normal and i n d i c a t e d no s e v e r e t u r b u l e n c e . 32:15 minutes a f t e r t a k e o f f abnormal
e x c u r s i o n s appear. The t a p e shows t h a t t h e a i r c r a f t s t a y e d a t 5,000 f e e t f o r a p p r o x i -
rrately 15 seconds a f t e r t h e beginning of t h e unusual e x c u r s i o n s and t h e n descended
r a p i d l y t o ground l e v e l w i t h l i t t l e change i n heading. The f l i g h t r e c o r d e r t a p e of
NAL 16 u/ showed no major d i f f e r e n c e s between t h e t r a c e s of t h e two a i r c r a f t while
t h e y were i n t h e h o l d i n g p a t t e r n , i n s o f a r as evidence of t u r b u l e n c e i s concerned.

The b o d i e s of a l l persons aboard t h e a i r c r a f t were recovered and i d e n t i f i e d .

T o x i c o l o g i c a l examination of t h e f l i g h t crew showed no evidence o f a l c o h o l o r
e l e v a t e d carbon monoxide l e v e l s . Carbon monoxide t e s t s of p a s s e n g e r s also i n d i -
c a t e d no e l e v a t e d l e v e l s . The f l i g h t crew was p h y s i c a l l y q u a l i f i e d f o r f l i g h t
a c c o r d i n g t o FAA and Pan American r e c o r d s .

The f l a m m a b i l i t y l i m i t s u/of a mixture of Type A and Type B f a l l somewhere

-
lo/ See f o o t n o t e 6,
-
11/ L i m i t s of a t h a t w i l l allow combustion t o occur. Below
t h e lower l i m i t t h e mixt,ure i s t,oo l e a n t o burn and above t h e h i g h e r limit t h e
m i x t u r e i s t o o r i c h t o burn.
 -9-
between t,he l i m i t s of e i t h e r f u e l examined s e p a r a t e l y . These l i m i t s vary a c c o r d i n g
t o t h e t e m p e r a t u r e and p r e s s u r e . Flammability i s a l s o a f f e c t e d by m i s t i n g o r foam-
irig of' t h e f u e l . Expert testimony a t t h e h e a r i n g i n d i c a t e d t h a t t h e f u e l v a p o r s i n
t h e a i r s p a c e s of t h e t a n k s were well w i t h i n t h e flammable range a t t h e time of t h e
accident.

Pan American World A i r w a y s conducted a f l i g h t t e s t i n a Boeing 707 t o determine

i f f u e l would d i s c h a r g e through t h e t a n k v e n t system ram a i r i n l e t . g/ There was no
v i s i b l e d i s c h a r g e of f u e l a t any time d u r i n g t h e t e s t . There was evidence t h a t f u e l
e n t e r e d t h e v e n t system, c o l l e c t e d i n t h e s u r g e t a n k s , and r e t u r n e d t o t h e proper
f u e l tanks.

To c l a r i f y t h e s u b j e c t of l i g h t n i n g , a U. S. Weather B u r e a u w i t n e s s was c a l l e d
t o t e s t i f y a t t h e h e a r i n g and v a r i o u s t e c h n i c a l r e p o r t s were reviewed. These
s o u r c e s i n d i c a t e t h a t a l i g h t n i n g s t r o k e b e g i n s when t h e a i r ' s r e s i s t a n c e t o t h e
passage of e l e c t r i c i t y b r e a k s down. A t t h a t time a f a i n t l y luminous s t e p p e d l e a d e r
advances toward a n a r e a of o p p o s i t e p o t e n t i a l , t h e e a r t h i n t h e c a s e of cloud t o
ground l i g h t n i n g . The d i f f e r e n c e i n e l e c t r i c a l p o t e n t i a l between a cloud and t h e
ground may be i n t h e o r d e r of t e n t o one hundred m i l l i o n v o l t s and d i s c h a r g e c u r r e n t s
may exceed 100,000 amperes w i t h 10,000 amperes p e r micro-second u/ r a t e of c u r r e n t
rise.

Tne stepped l e a d e r advances toward t h e ground i n a s e r i e s of d i s c r e t e branching

movements, forming a n i o n i z e d p a t h down from t h e cloud. A s a branch of t h e stepped
l e a d e r i s approaching t h e ground, t h e i n t e n s i f i e d e l e c t r i c f i e l d c a u s e s a n upward
moving s t r e a m e r t o form a t a ground p r o j e c t i o n and advance toward t h e stepped l e a d e r .
A s t h e o p p o s i t e l y charged l e a d e r s meet, completing t h e i o n i z e d channel, a n avalanche
of e l e c t r o n flow f o l l o w s , d i s c h a r g i n g t h e cloud t o t h e ground. T h i s e n t i r e sequence
i s accomplished i n approximately one m i l l i s e c o n d . &/ A d d i t i o n a l charge c e l l s i n
t h e cloud may t h e n s u c c e s s i v e l y d i s c h a r g e through t h i s main i o n i z e d channel as a
s i n g l e f l i c k e r i n g f l a s h which may l a s t as l o n g as one second. The e l e c t r o n flow
suddenly h e a t s t h e i o n i z e d channel t o about 15,0OO0C., expanding t h e a i r super-
s o n i c a l l y outward w i t h a t h u n d e r c l a p . The d i s c h a r g e can a l s o occur between oppo-
s i t e l y charged r e g i o n s w i t h i n a c l o u d , or i n d i f f e r e n t clouds.

If t h e stepped l e a d e r of a s t r o k e approaches a f l y i n g a i r c r a f t , t h e i n t e n s e
e l e c t r i c f i e l d i n d u c e s s t r e a m e r s from t h e e x t r e m i t i e s of t h e a i r c r a f t out toward
t h e approaching s t r o k e . The stepped l e a d e r c o n t a c t s one of t h e s e a i r c r a f t s t r e a m e r s ,
completing t h e i o n i z e d channel t o t h e a ' r c r a f t and r a i s i n g t h e p o t e n t i a l of t h e a i r -
c r a f t t o t h e o r d e r of 100 megavolts. 157 T h i s h i g h p o t e n t i a l produces s t r e a m e r s
from a l l t h e e x t r e m i t i e s and h i g h g r a d i e n t p o i n t s of t h e a i r c r a f t . These s t r e a m e r s
can have s u f f i c i e n t energy t o i g n i t e f u e l vapors. Meanwhile, t h e s t r o k e l e a d e r con-
t i n u e s on from t h e a i r c r a f t t o a n o t h e r cloud or t o t h e ground t o complete t h e i o n i z e d
channel f o r t h e e l e c t r o n avalanche.

12/ The t e s t c o n d i t i o n s were: F u e l v e n t s h u t o f f f l o a t v a l v e s removed from Nos.

3 a n d 7 main t a n k s and f l o a t v a l v e s i n t h e Nos. 1 and 2 main t a n k s i n t a c t ; 12,000
pounds of f u e l i n t a n k s 1, 2, 3, and 4 main and w i t h t h e r e s e r v e and o u t e r t a n k s
empty; f l i g h t c o n d i t i o n s s i m u l a t i n g moderate t o rough a i r t u r b u l e n c e w i t h s k i d d i n g
two minutes t u r n s .
13/ A micro second i s one m i l l i o n t h of a second.
g/ One t h o u s a n d t h of a second.
15/ Megavolt - e q u a l s one m i l l i o n v o l t s .
I
 - 10 -
S t a t i s t i c s i n d i c a t e thaL t h e m a j o r i t y of l i g h t n i n g s t r i k e s t o aircrai'i,
o c c u r a t ambient t e m p e r a t u r e s n e a r t h e f r e e z i n g l e v e l . T h i s c o r r e l a t e s withi
thunderstorm e l e c t r i f i c a t i o n t h e o r i e s t h a t charge s e p a r a t i o n occurs about the
f r e e z i n g l e v e l . N709PA was a t o r n e a r t h e f r e e z i n g l e v e l j u s t p r i o r t o t h e a c c i -
dent.

ANA L YS IS

The f l i g h t crew o f N709PA was p r o p e r l y c e r t i f i c a t e d and q u a l i f i e d f o r t h i s

f l i g h t . The f l i g h t was p r o p e r l y d i s p a t c h e d and c l e a r e d , and conformed t o t h e a i r
t r a f f i c c o n t r o l r u l e s . The h i s t o r y of t h i s a i r c r a f t r e v e a l s no i t e m t h a t s t a n d s
i n causal relationship with t h e accident.

No e v i d e n c e o f any f l i g h t crew i n c a p a c i t a t i o n , p r i o r t o impact, was found.

A i r c a r r i e r a i r c r a f t o p e r a t e d i n t o and o u t of P h i l a d e l p h i a immediately b e f o r e
a n d a f t e r t h e a c c i d e n t . There were s c a t t e r e d t h u n d e r s t o r m s and areas of s e v e r e
t u r b u l e n c e i n t h e P h i l a d e l p h i a area. However, t h e t u r b u l e n c e i n t h e area where
N709PA was o p e r a t i n g was l i g h t t o moderate and was n o t of t h e s t r e n g t h normally
a s s o c i a t e d w i t h a loss o f c o n t r o l o r s t r u c t u r a l f a i l u r e . Even though t h e a i r c r a f t
was o p e r a t i n g i n p r e c i p i t a t i o n a t or n e a r t h e f r e e z i n g l e v e l , i c i n g i s n o t c o n s i d e r e d
a factor.

The weather documentation and b r i e f i n g f u r n i s h e d t h e crew a t San Juan was sat-

i s f a c t o r y . The weather s e r v i c e p r o v i d e d t h e crew a t B a l t i m o r e was not complete; how-
e v e r , a l l t h e weather d a t a a v a i l a b l e i n d i c a t e d t h a t t h e c o l d f r o n t would be p a s t
P h i l a d e l p h i a and t h e weather would be improving upon t h e i r a r r i v a l . By d e f i n i t i o n ,
l i g h t n i n g i s always present, i n t h u n d e r s t o r m s . A t t h e time and p l a c e of t h e a c c i d e n t
a t h u n d e r s t o r m was p r e s e n t and l i g h t n i n g was observed and s c a t t e r e d t h u n d e r s t o r m s
were f o r e c a s t f o r t h e area.

The r e c o r d i n d i c a t e s t h a t t h e f l i g h t was normal u n t i l 32:15 m i n u t e s a f t e r t a k e -

o f f from B a l t i m o r e . The a b e r r a t i o n s a p p e a r i n g i n t h e t r a c e s of N709pA's r e a d o u t a t
32:15 a f t e r t a k e o f f i n d i c a t e s t h e t i m e of t h e e x p l o s i o n i n t h e l e f t wing. The p i l o t
was a b l e t o m a i n t a i n c o n t r o l only a few seconds a f t e r t h a t and t h e n t h e a i r c r a f t
dove i n t o t h e ground.

There was no e v i d e n c e of any powerplant o r s y s t e m m a l f u n c t i o n t h a t could have

caused t h e i r i f l i g h t e x p l o s i o n . However, due t o t h e i n f l i g h t f i r e damage i n t h e l e f t
i n b o a r d wing t r a i l i n g edge, t h e l e f t h o r i z o n t a l t a i l and t h e l e f t s i d e of t h e v e r t i -
c a l t a i l and a f t f u s e l a g e , t h e p o s s i b i l i t y of a f u e l l e a k i n t h e t r a i l i n g edge of
t h e l e f t i n b o a r d wing was e x p l o r e d i n c o n n e c t i o n w i t h i n i t i a t i o n o f t h e a c c i d e n t .
P o s s i b l e s o u r c e s of such l e a k s a r e t h e dump c h u t e assembly, Lhe r e s e r v e t a n k t r a n s -
f e r tube, o r a r e a r s p a r crack.

F u e l r e l e a s e d i n t o t h e t r a i l i n g edge c o u l d be i g n i t e d and t h e c a v i t i e s i n t h e
wing t r a i l i n g edge woiild a c t a flame h o l d e r s making c o n t i n u e d b u r n i n g l i k e l y . A l -
though t h e d i h e d r a l a n g l e of t h e wing i n normal f l i g h t would t e n d t o cause a n i n -
b o a r d flow of some of t h e r e l e a s e d f u e l a l o n g t h e rear s p a r lower edge, v a r i o u s
o b s t r u c t i o n s i n t h e t r a i l i n g edge and chordwise d i s c o n t i n u i t i e s i n the lower s u r f a c e
of' t h e t r a i l i n g edge would t e n d t o l o c a l i z e any f i r e t o t h e g e n e r a l a r e a of t h e l e a k .
A s a r e s u l t any l e a k a p p r e c i a b l y i n b o a r d of t h e r e s e r v e t a n k t r a n s f e r t u b e could not
 - 11 -
be expected t o cause a f i r e t h a t would p r o g r e s s outward and h e a t t h i s t u b e s u f f i c i -
ent,ly t o i g a i t e t h e f u e l l a i r m i x t u r e i n t h e No. 1 r e s e r v e t a n k p r i o r t o f a i l u r e of
t h e wing f a r t h e r inboard. A l e a k i n t h e g e n e r a l v i c i n i t y of t h e t r a n s f e r t u b e
c o u l d p o s s i b l y produce t h i s r e s u l t , b u t t h e f i r e could n o t be expected t o p r o g r e s s
through t h e t r a i l i n g edge almost t o t h e f u s e l a g e , c a u s i n g t h e observed i n f l i g h t f i r e
damage p r i o r t o f a i l u r e of t h e wing n e a r t h e s o u r c e of t h e f i r e .

I n a d d i t i o n , t h e metal s p l a t t e r on t h e l e f t h o r i z o n t a l s t a b i l i z e r l e a d i n g edge
and i n f l i g h t f i r e damage t o t h e l e f t e l e v a t o r could occur only a f t e r l o s s of t h e
l e f t o u t e r wing. I n normal f l i g h t t h e a i r f l o w over t h e wing and m a t e r i a l s s e p a r a t -
i n g from t h e wing t r a i l i n g edge p a s s w e l l below t h e h o r i z o n t a l t a i l r a t h e r t h a n
s t r i k i n g i t and do n o t have t h e sideward component of t r a v e l d i s p l a y e d by t h e m e t a l
s p l a t t e r s . Also, t h e f i r e damage h i g h on t h e l e f t s i d e of t h e v e r t i c a l t a i l i s
wholly i n c o m p a t i b l e w i t h f i r e emanating f r o m . t h e wing t r a i l i n g edge under any normal
f l i g h t conditions.

From t h e f a c t s of t h e i n v e s t i g a t i o n , it h a s been determined t h a t e x p l o s i o n s

o c c u r r e d i n t h e l e f t r e s e r v e , c e n t e r and r i g h t r e s e r v e f u e l t a n k s . The wreckage
d i s t r i b u t i o n , supported by t h e f i r e damage p a t t e r n , l e a d s t o t h e c o n c l u s i o n s t h a t
t h e i n i t i a l e x p l o s i o n was i n t h e l e f t r e s e r v e t a n k and t h a t no fire-damaged p a r t
s e p a r a t e d from t h e a i r c r a f t p r i o r t o t h e e x p l o s i o n .

The e x a c t sequence and t i m i n g of t h e subsequent e x p l o s i o n s and i n f l i g h t f i r e s

a r e n o t known and are, i n f a c t , somewhat academic w i t h r e s p e c t t o t h e p r o b a b l e
c a u s e of t h e a c c i d e n t . F i r e s were observed on b o t h wings of t h e a i r c r a f t b e f o r e
impact. I t i s l o g i c a l l y concluded t h a t main t a n k s which c o n t a i n e d f u e l and a r e
a d j a c e n t t o t h e r e s e r v e and c e n t e r t a n k s were s t r u c t u r a l l y d i s r u p t e d when some or
a l l of t h e aforementioned t a n k s exploded; f u e l was s p i l l e d and i g n i t e d . Such s p i l l -
a g e from t h e opened o u t e r end of t h e No. 1 main t a n k and f i r e damage t o p a r t s a f t
t h e r e o f , i n c l u d i n g t h e s t i l l a t t a c h e d i n n e r ends of t h e o u t e r p a n e l r e a r s p a r and
outboard a i l e r o n , a r e q u i t e a p p a r e n t . E a r l y s e p a r a t i o n of t h e outboard e n g i n e s i n
t h e sequence of e v e n t s may have c o n t r i b u t e d , a t l e a s t i n p a r t , t o t h e l a r g e f i r e s
t h a t were observed on t h e wings.

Although much e f f o r t was expended, t h e p h y s i c a l evidence f a i l e d t o d i s c l o s e

t h e p r e c i s e mechanism of i g n i t i o n which t r i g g e r e d t h e e x p l o s i o n i n t h e l e f t r e s e r v e
f u e l t a n k . However, w i t n e s s e s , some p a r t i c u l a r l y w e l l q u a l i f i e d , observed a cloud
t o e a r t h l i g h t n i n g d i s c h a r g e , d e s c r i b e d as b e i n g of e x c e p t i o n a l l y g r e a t magnitude,
i n t h e immediate l o c a t i o n from which, moments l a t e r , t h e b u r n i n g a i r c r a f t emerged.
Before o b s e r v i n g t h e a i r c r a f t , a glow or l i g h t was observed i n n e a r proximity t o
t h e l o c a t i o n of t h e l i g h t n i n g d i s c h a r g e . Consequently, t h e r e i s a d i r e c t c o r r e l a -
t i o n i n time and l o c a t i o n between t h e l i g h t n i n g d i s c h a r g e and start of e v e n t s which
culminated i n t h e a c c i d e n t .

L i g h t n i n g d i s c h a r g e damage judged t o b e of r e c e n t o r i g i n and of a n e x t e n t com-

p a t i b l e w i t h t h e r e p o r t e d l y observed massive l i g h t n i n g s t r o k e was observed i n
s e v e r a l l o c a t i o n s a t t h e l e f t wing t i p area. I t i s p e r t i n e n t t o n o t e , however,
t h a t none of t h e damage was on wing s k i n t h a t encompassed f u e l t a n k or v e n t system
s p a c e of t h e a i r c r a f t ; consequently, a d i r e c t c o r r e l a t i o n of any of t h i s damage w i t h
t h e t a n k e x p l o s i o n i s not p o s s i b l e .

E x t e n s i v e and m e t i c u l o u s e f f o r t was expended a t t e m p t i n g t o f i n d evidence of a n

e l e c t r i c a l d i s c h a r g e t h a t may have i g n i t e d t h e flammable m i x t u r e i n t h e l e f t r e s e r v e
t a n k w i t h n e g a t i v e r e s u l t s . The guidance and a s s i s t a n c e of r e c o g n i z e d a u t h o r i t i e s
i n t h e f i e l d of ligkit,riiLig p h y s i c s and r e s e a r c h were a v a i l c ' u l e and used i n t h i s
p h a s e of' t h e i n v e s t i g a t i o i i . P a r L i c u l a r a t t e n t i o n was devoted t o f u e l q u a n t i t y
p r o b e s , d i s c o n t i n u i t i e s i l l t h e s t r u c t u r e which form t h e f u e l t a n k s bonding, f u e l
t a n k a c c e s s p l a t e s , f i l l e r c a p a s s e m b l i e s , f u e l v e n t o u t l e t s and a l s o t a n k wall sur-
f a c e s . I n f o r m a t i o n o b t a i n e d by a n a l y s e s , r e s e a r c h u t i l i z i n g l a b o r a t o r y produced
e l e c t r i c a l d i s c h a r g e s and o b s e r v a t i o n s o f n a t u r a l l i g h t n i n g damage was u t i l i z e d i n
d e t e r m i n i n g where and how t o make t h e d e t a i l e d examination.

Although p h y s i c a l evidence of t h e means by which i g n i t i o n o c c u r r e d was n o t

found, t h e l i k e l i h o o d of i g n i t i o n by l i g h t n i n g i s n o t r u l e d o u t . The c o r r e l a t i o n
o f time, p l a c e and damage cannot be d i s m i s s e d . C e r t a i n phenomena a s s o c i a t e d w i t h
l i g h t n i n g d i s c h a r g e s , some w e l l d e f i n e d , o t h e r s more s u b t l e and of which we have
l e s s f i n i t e i n f o r m a t i o n and which l e a v e no p h y s i c a l e v i d e n c e can i g n i t e flammable
mixtures. P r o b a b l y most s i g n i f i c a n t i n t h e former c a t e g o r y i s t h e development o f
streamers from e x t r e m i t i e s and/or s u r f a c e d i s c o n t i n u i t i e s as a l i g h t n i n g s t r o k e de-
v e l o p s i n t h e s t e p l e a d e r s t a g e . These streamers have been found t o b e i n t h e dura-
t i o n and energy r a n g e r e q u i r e d t o i g n i t e flammable mixtures. Other phenomena, of
which less i s known because o€ g e n e r a t i o n and measuring d i f f i c u l t i e s , t h a t a r e con-
s i d e r e d p o t e n t i a l i g n i t i o n s o u r c e s are plasma., shock waves and s p a r k i n g due t o i n -
duced v o l t a g e s from e x t r e m e l y h i g h c u r r e n t r i s e r a t e s t h a t occur. Although much
h a s been l e a r n e d a b o u t l i g h t n i n g and i t s e f f e c t s t h r o u g h r e s e a r c h and s t u d y , many
q u e s t i o n s a r e s t i l l unanswered and t h e upper limits of v o l t a g e , c u r r e n t and t o t a l
energy t h a t may be a s s o c i a t e d w i t h l i g h t n i n g a r e n o t c o n c l u s i v e l y d e f i n e d . The
a p p a r e n t c a p r i c i o u s n a t u r e of l i g h t n i n g i s evidenced by t h e range of extremes as
w e l l as, i n some c a s e s , t h e unique n a t u r e o f t h e damage t h a t r e s u l t s . Thus, t o
p r e d i c t i n t h e a b s e n c e of p h y s i c a l e v i d e n c e t h e e x a c t mechanism of i g n i t i o n i n t h i s
p a r t i c u l a r c a s e i s n o t p o s s i b l e . By t h e same r e a s o n i n g , i n view of' t h e known f a c t s
of t h i s a c c i d e n t , t h e r e i s no l o g i c a l e x p l a n a t i o n for i g n i t i o n of t h e flammable
v a p o r s o t h e r t h a n some e f f e c t stemming d i r e c t l y from t h e l i g h t n i n g s t r i k e .

The v e n t s y s t e m i n t e r c o n n e c t s a l l f u e l t a n k s and t h e v e n t o u t l e t s t h r o u g h p a s s -
a g e s c a p a b l e of t r a n s m i t t i n g flame when f i l l e d w i t h flammable m i x t u r e s ; t h u s i n i t i a l
i g n i - t i o n c o u l d have o c c u r r e d i n s i d e t h e l e f t r e s e r v e t a n k , i n s i d e t h e l e f t s u r g e
t a n k , o r at, t h e l e f t v e n t o u t l e t .

Rased on e v i d e n c e f u r n i s h e d t h e Board, i t i s r e a s o n a b l e t o conclude t h a t t h e

s t a t e of t h e a r t was f u l l y e x p l o i t e d w i t h i n t h e l i m i t s imposed by b a s i c a i r p l a n e
s t r u c t u r a l and c o n f i g u r a t i o n r e q u i r e m e n t s i n t h e d e s i g n of t h e f u e l system, i n c l u d -
i n g t h e v e n t o u t l e t s . A p p l i c a t i o n of known l i g h t n i n g p r o t e c t i o n i n f o r m a t i o n as
w e l l a s s p e c i f i c t e s t i n g u a s a p p l i e d d u r i n g t h e d e s i g n s t a g e s . The l i g h t n i n g pro-
t e c t i o n r e q u i r e m e n t s of t h e F e d e r a l A v i a t i o n Agency were s a t i s f i e d .

The F e d e r a l A v i a t i o n Agency sponsored r e s e a r c h , i n i t i a t e d immediately subse-

q u e n t t o t h e a c c i d e n t , w i t h t h e i n t e n t of improving p r o t e c t i o n from i g n i t i o n o f t ' u e l
by l i g h t n i n g s t r i k e s t o a i r c r a f t . The Board p a r t i c i p a t e d i n t h i s program by pro-
v i d i n g a member on t h e Committee o r g a n i z e d t o a d v i s e i n t h e program p l a n n i n g and
e x e c u t i o n a s well as t o e v a l u a t e t h e r e s u l t s . The Committee was informed c u r r e n t l y
on t h e i n v e s t i g a t i v e r e s u l t s a n d , c o n v e r s e l y , p e r s o n s r e s p o n s i b l e f o r t h e i n v e s t i -
g a t i o n were a d v i s e d as i n f o r m a t i o n evolved from t h e r e s e a r c h a c t i v i t i e s t o t h e
m u t u a l b e n e f i t of a l l r e s p o n s i b l e p a r t i e s . Although t h e c i r c u m s t a n c e s and f a c t s
of t h e a c c i d e n t were a p p l i e d i n t h e p l a n n i n g of t h e r e s e a r c h program, i t s scope and
i n t e n t was t o p r o v i d e i n f o r m t i o n t h a t c o u l d b e a p p l i e d industry-wide and t h u s was
 - 13 -
not aimed :it, any s p e c i f i c a i r c r a f t . Consequently, only t h a t p o r t i o n of t h e program
t h a t a p p e a r s t o be r e l e v a n t t o t h e s u b j e c t a c c i d e n t w i l l b e d i s c u s s e d .

One e f f o r t i n t h i s r e g a r d was a review by t h e C o o r d i n a t i n g Research Council of

all a v a i l a b l e d a t a concerning t h e r e l a t i v e safety of Type A and Type B j e t f u e l s and
m i x t u r e s t h e r e o f . The group making t h i s study concluded t h a t w h i l e t h e r e are d i f -
f e r e n c e s , t h e a d o p t i o n of a s i n g l e t y p e of a v i a t i o n t u r b i n e f u e l by t h e e n t i r e i n -
d u s t r y would not s i g n i f i c a n t l y improve t h e o v e r a l l e x c e l l e n t s a f e t y r e c o r d of com-
m e r c i a l a v i a t i o n . The group f u r t h e r concluded t h a t a d d i t i o n a l r e s e a r c h i n t o t h e
n a t u r e and e f f e c t of l i g h t n i n g s t r i k e s and e l e c t r o - s t a t i c d i s c h a r g e s i s warranted
and t h a t more i n f o r m a t i o n i s d e s i r a b l e r e g a r d i n g t h e phenomena of f u e l s p r a y ,
m i s t z i n g , and l o c a l i z e d vapor-air m i x t u r e s i n t a n k s under a c t u a l f l i g h t c o n d i t i o n s .
The F e d e r a l A v i a t i o n Agency i s implementing r e s e a r c h and t e s t programs t o accomplish,
i n t h e main, t h e C o o r d i n a t i n g Research C o u n c i l ' s recommendations.

I t was demonstrated t h a t d i r e c t l i g h t n i n g s t r i k e s t o over wing f i l l e r caps and

a c c e s s p l a t e s of t h e c o n f i g u r a t i o n used on t h e a i r c r a f t i n q u e s t i o n can produce
s p a r k s i n s i d e t h e f u e l t a n k . No evidence of a d i r e c t s t r i k e was found on t h e s e
p a r t s from N709PA. P r a c t i c a l means whereby t h e s e p o t e n t i a l h a z a r d s can be e l i m i -
n a t e d , as demonstrated w i t h i n t h e limits of t h e t e s t i n g f a c i l i t y , were developed
a n d , i n t h e c a s e of a c c e s s p l a t e s , have a l r e a d y been a p p l i e d t o a i r c r a f t i n s e r v i c e .
T e s t i n g f a i l e d t o demonstrate any hazard from induced v o l t a g e s i n t h e f u e l q u a n t i t y
measuring system. A complete wing s e c t i o n of e s s e n t i a l l y t h e same c o n f i g u r a t i o n as
B707-121 was t e s t e d f o r i n t e r n a l s p a r k i n g i n t h e r e s e r v e tank. S i m u l a t i o n of
l i g h t n i n g s t r i k e s t o t h e e x t e n t of t h e t e s t i n g f a c i l i t y c a p a b i l i t y d i d n o t produce
any recorded evidence of s p a r k i n g w i t h i n t h e tank.

The t e s t i n g f a c i l i t y t h a t was used i s recognized as b e i n g among t h e most pro-

f i c i e n t i n t h e f i e l d of l i g h t n i n g s i m u l a t i o n and r e s e a r c h . It i s f e l t t h a t t h e
c u r r e n t s t a t e of t h e a r t does not permit a n e x t e n s i o n of t e s t r e s u l t s t o u n q u a l i f i e d
c o n c l u s i o n s of a l l a s p e c t s of n a t u r a l l i g h t n i n g e f f e c t s . The need f o r a d d i t i o n a l r e -
s e a r c h i s recognized and a d d i t i o n a l programming i s planned.

P r o b a b l e Cause

The Board d e t e r m i n e s t h e p r o b a b l e cause of t h i s a c c i d e n t was lightning-induced

i g n i t i o n of t h e f u e l / a i r m i x t u r e i n t h e No. 1 r e s e r v e f u e l t a n k w i t h r e s u l t a n t ex-
p l o s i v e d i s i n t e g r a t i o n of t h e l e f t o u t e r wing and l o s s of c o n t r o l .

BY THE C I V I L AERONAUTICS BOARD:

/s/ ALAN S. BOYD

Chairman

/s/ ROBERT T . MURPHY

Vice Chairman

/s/ CHAN GURNEY

Member

/s/ G. JOSEPH MINETTI

Member

/s/ WHITNEY GILLILLAND

Member
 SUEELEMENTAL DATA
I rivest i g a t -i.on

The C i v i l A e r o n a u t i c s Board was n o t i f i e d of t h i s a c c i d e n t on December 8, 1963,

and a n i n v e s t i g a t i o n was immediately i n i t i a t e d under t h e p r o v i s i o n s of T i t l e V I 1
of t h e F e d e r a l A v i a t i o n Act of 1958, as amended. A p u b l i c h e a r i n g was conducted
as p a r t of t h i s i n v e s t i g a t i o n a t P h i l a d e l p h i a , Pennsylvania, February 24-26, 1964.

A i r Carrier

Pan American World Airways, I n c . , i s a New York c o r p o r a t i o n w i t h h e a d q u a r t e r s

a t New York C i t y , New York.

The company o p e r a t e s as a scheduled a i r c a r r i e r under a c u r r e n t l y e f f e c t i v e

c e r t i f i c a t e o f p u b l i c convenience and n e c e s s i t y i s s u e d by t h e C i v i l A e r o n a u t i c s
Board, and a n o p e r a t i n g c e r t i f i c a t e i s s u e d by t h e F e d e r a l A v i a t i o n Agency.

F l i g h t Personnel

C a p t a i n George F. Knuth, age 4.5, h e l d a c u r r e n t a i r t r a n s p o r t p i l o t c e r t i f i c a t e

No. 796-40 i s s u e d A p r i l 20, 1953, w i t h t y p e r a t i n g s i n B-707, DC-6, DC-3, and L-49.
He a l s o had n a v i g a t o r ’ s r a t i n g . C a p t a i n Knuth had 17,049 hours t o t a l f l y i n g time of
which 2,890 hours were i n t h e B-707. H i s l a s t Class I p h y s i c a l examination was
accomplished i n December 1963 and no waiver was r e q u i r e d .

F i r s t O f f i c e r John R. Dale, age 48, h e l d a c u r r e n t a i r t r a n s p o r t p i l o t c e r t i f i -

c a t e 4.50373 i s s u e d November l4, 1955, w i t h t y p e r a t i n g s i n t h e B-707, L-49, B-377,
and n a v i g a t i o n . He had a t o t a l of 13,963 h o u r s f l y i n g time of which 2,681 hours
were i n B-707 a i r c r a f t . H i s l a s t p h y s i c a l examination was completed i n August, 1963,
w i t h no waivers.

Second O f f i c e r P a u l L. O r r i n g e r , age 42, h e l d a n a i r t r a n s p o r t p i l o t c e r t i f i c a t e

220082, i s s u e d A p r i l 6, 1962, w i t h t y p e r a t i n g s i n DC-6, DC-3, and n a v i g a t i o n . He
had 10,008 t o t a l f l y i n g hours i n c l u d i n g 2,808 i n B-707 a i r c r a f t . H i s l a s t p h y s i c a l
examination was completed i n June, 1963, w i t h no waivers.

F l i g h t Engineer John R. Kantlehner, h e l d a n a i r c r a f t and powerplant mechanic

c e r t i f i c a t e and a f l i g h t e n g i n e e r c e r t i f i c a t e . The l a t t e r was i s s u e d December 14,
1955. He had a t o t a l f l y i n g time of 6,066 hours i n c l u d i n g 76 h o u r s i n t h e B-707.
H i s l a s t p h y s i c a l examination was completed October 1, 1963, w i t h no w a i v e r s .

The c a b i n a t t e n d a n t s were p r o p e r l y t r a i n e d and q u a l i f i e d for t h e p o s i t i o n s i n

which they were s e r v i n g .

The A i r c r a f t

The a i r c r a f t , a Boeing 707-121, N709PA was purchased by Pan American i n 1958,

and had a t o t a l f l y i n g time of l4,609 hours. The l a s t major i n s p e c t i o n was performed
March 25, 1963, and t h e l a s t l a y o v e r t r a n s i t i n s p e c t i o n December 7, 1963.
 'Tlie x i L n c t + a U L was powered by four P r a t t a n d Wkiitr.ey J'l'X-6 t u r b o j e t erigiricA,,.
T i i s t o t a l time ('Ill') arid times s i n c e o v c r h i i l (TSO) of t h e s e engines were:

Engine No. T'r (Hours) TSO ( I l o u r s )

1 8593 618
2 8328 1419
3 3623 3149
4 9446 2371
L
cO
pv

DEC 17 1963

Mr. George S . Moore

Director
F l i g h t Standards Service
Federal Aviation Agency
Washington, 3 , C . , 20553

Uear Mr. Moore:

The investigation t o cfate of the Pan American World Airways,

Inc., Boeing 707-121, NIIGYPA, a i r c r a f t accident near Elkton, Maryland
on December 8, 1963, has i d e n t i f i e d i n a gmsa SBZSB the causal areas.
That an i n f l i g h t explosior cccurred i n t h e No. 1 reserve f u e l tank
i s r e a d i l y evident, It i s believed t h e explosion stemmed from i g n i t i o n
of combustible fumes a t the fuel tanks vent o u t l e t by a lightning
s t r i k e . Positive evidence of lightning s t r i k i n g i n the wing t i p area,
some near the vent system o u t l e t , has been noted. The investigation,
t o , a t t e m p t t o more precisely define the mechanism of initial i g n i t i o n
and progress t o explosion, is continuing.
Fuel aboard a t the time of the accident was approximately a
68/32 Jet k/Jet B by volume mix, Based on data furnished by PAWA, i t
i s estimated the temperature of the f u e l was approximately k2 degrees E’.
Except f o r normally unuseable f u e l , all was being carried i n the four
main tanks. Considering a l l f a c t o r s , i t is concluded the f u e l vapors
in all tanks were within t h e flammability limits,
This accident has focused a t t e n t i o n on a serious problem; not new
a s evidenced by the s t u d i e s previously mad? and the great number of
reports and papers dealing with i t . There i s no doubt i n our mind t h a t
our concern regarding t h i s matter is shared equally by yourself and
s t a f f . It i s appreciated a l s o t h a t immediately a t t a i n a b l e corrective
measures t o provide t o t a l protection a r e not r e a d i l y evident. However,
we do f e e l and urge t h a t a l l available government and i n i u s t r y resources
should be marshalled t o implement protective measures. Even p a r t i a l
measures e f f e c t i n g d e f i n i t e improvement appear warranted before t h e
ultimate protection can be provided.
The following recommendations f o r your consideration a r e submitted:

1. I n s t a l l s t a t i c discharge wicks on those turbine powered air-

c r a f t not so equipped.
2. &evaluate problems associated w i t h incorporation of flame
arrestors i n fuel tank v m t o u t l e t s . We believe p o s i t i v e
protection against Euel tank: explosion from s t a t i c discharge
i b n i t e d fuel/air mixtures a t f u e l tank: vent outlets can be
1-rovided by flame arrestors having sufficient depth.

3 . A possible a l t e r n a t e t o N o , 2 c h a t may
be considered i s t o
render t h e n;ix%ure emitting f ram the vent outlet non-ignitable
by the introduction of air into the vent tube.

J. be believe t h e surge tanks located j u s t outboard of the re-

serve tanks: by v i r t u e of their location near t h e wing tip,
a r e vulnerable mth r e s p e c t t o lightriing strikeso Burn marks
on the skin i n the tip area o f N709PA substantmtus "Lie
belief, This being tfie case. it is believed a measire of
protection w i l l be a t t a A 4 e dif the \iring skir. is n o t u t i l i z e d
as part of the surge tank walls. This coulc: bs accomplisned
by providing an i::nsr wai; d s , h u,a:.r gzp between it m d
the wing s ~ i nt o f x m s-wgc tank, Ik is reconmended t h a t
this canccgt be ccnsxdered. Ar*otZ?cr iLLtcrardtc I?.2par~$0
provide s.;i:icient thlzkness of the skin in t k k s area to pre-
V E bur.zin.6
~ t,",r~ugh c y l i g h t n i w S ~ F L ~ S S

5. Suggested for. conssderation i s the r e q d i r e m n t t h a t o n l y J e t %!

fuel be ased c2mercially. Vapor ,"lammability tenpesature

lL!Ltc chsrtc x;r~videdby 3sso sk,acw t h a t .!!wF less 32 t h e
aticss wczlrf DCCW wzth t h e vapor ;n the .9:lewadx2..ityrange
while w i . ~ gJc: A fuel as compared mth J e t 3 f u e l .
&; Oeorge S , Moore (3)

The above recommenktions amplify our- tlelephone conversation.

of 'becember 11 andlour meeting OR ikcember' 12'i Through your par-
ticipation in the investigation of the accident as well as by d i r e c t
oontact from this o f f i c e , you will be advised of current devebopnto:
auq-we13 ra,of aw other t h i n k i u we msy hove rsgardlng aorrectivv
measures. M y ataff will also be available for'any assistance wa can
provide to .resolve this -safety.problemc

Sincerely yours,
O r i g i n a l signed-by
Leon H. Tanguay
h o n H. Tanguay
Dimutor, Bureau of Shfety.

. . ,
 ATTACHMENT I11

..
, 1,.

F E D E R A L AVIATION AGENCY
;:rs!L ii0Ul.I
W.d-;!:icron D.C. 20553

Mr. Leon H. Tanguay

Director, Bureau of Safety
Civil Aeronautics Board
Washington, D. C. 20428

Dear Mr. Tanguay:

This will supplement Oi.11. J a t i u a r y 2, 1964, acknowledgment to your letter,

reference B-80-96, dated December 17, 1963, regarding the Pan American
World Airways, Inc., Baeing 707-121, N709PA, aircraft accident near
Elkton, Maryland, on Decenibcr 8, 1963.

The recommendations and sughe~;t:ions offered in your letter of December 17,

1963, have been carefully cmsidered along with other ideas for achieving
improved protection against lightning strikes. This Agency is engaged
in a program of studies, t e s t s , arid investigations to provide information
.
essential to the development: aitd application of superior protective
measures.

Although the investigation of t h e accident has not yet disclosed evidence

of the mechanism by which a lightning strike ignited the fuel, we have
a p p l i e d certain precautionary measures, each of which offers some degree
of benefit. These are:
NOTAM issued on Decernbc.; : 3 , 1963, alerting pilots and traffic
controllers to lightning hazards, need for thunderstorm avoid-
.
ance, and encouraging u s ? of PIEUlPS:*

Telegram to air carricrs and aircraft operators, on December 18,

1963, recommending tIic installation of static dischargers on
all aircraft using turbine fuels.

Airworthiness Directtvc on Boeing 707, 720, and 727 series

aircraft, requirinj.4 moiification of fuel tank access door
bonding, issued or, E'ehruary 4 , 1964, as an adopted rule.

Airworthiness Directive on Boeing 707 and 720 series aircraft,

requiring overlay on surge tank skin for improved protection
against penetration, i.ssued on February 21, 1964, as an
adopted rule.
 2

Information on all aspects of our program was given by the Federal

Aviation Agency witnesses in testimony before the Board of Inquiry at
Philadelphia on February 25. This letter, therefore, is limited to a
brief account of program status,
Technical Committee

A Technical Committee on lightning protection for aircraft

fuel systems has been formed, composed of representation from
the FAA, Civil Aeronautics Board, National Aeronautics and
Space Administration, U. S. Weather Bureau, U. S. Air Force,
and U. S. Navy. The Conunittee has been meeting regularly
and is providing guidance and assistance in planning and
carrying out specific actions.

Installation of static dischargers

The response to the telegraphic recommendation of December 18,

1963, has been completely favorable. Installations are being
made as parts become available. Late reports show that about
24 air carrier airplanes are y e t to have dischargers installed.
Availability of parts is the main factor in completing the
remainder.

Collection and auai,vsis o f data

We are receiving lightning strike data from all available

sources. These data are being consolidated and analyzed with
the assistance of the Technical Committee.

Contract with Atlantic Research Corp. (FA64WA-4955, dated

January 30, 1364, A m o m t , $70,259 .OO)

This work includes the evaluation q f flame arcester designs

for effectiveness, and studies and tests on other ways of
-
protecting the vent system such as explosion suppression and
ventilation of vent outlet. Equipment,calibrationtests are
now being conducted.

Contract w i t h L i g h t n i n g and Transients Research Institute

(FA64WA-4960, dzted gebruary 4, 1964, Amount, $96,748,951

This contractor is investigating the internal arcing possibilizy

on typical wing tank construction, and will evaluate means of
eliminating any arcs found to exist. Later, proof tests of
promising flame arrester designs will be conducted. The test
article is in place and inirial discharges are being fired to
check out the equipment.
 3
Planning for comprehensive research and development pro-iects

A more comprehensive program of research and development will

-
be required for the purpose of refining design criteria, making
advanced rtudieol o f protection concepts in general covrring
&re168of invaotigation not possible in the short-range contract8
with Atlantic Research Corp. and LTRI. The Technical Committee

.
is now considering suggestions for the scope and nature of the
project8

Fuels study

The questions which have been raised concerning the relative

safety 'of JP-4, kerosene, and mixes of the two are being studied.
'Eo assist in the resolution of these questions, we have asked
the Coordinating Research Council to undertake a review of all
available data on the subject. The CRC is proceeding with this
work, which will serve to define the PDstateof the art," iden-
tify areas where research may be needed, and recommend how t o
accomplish any needed research. In addition, we have issued
Advisory Circular No. AC 20-20, which furnishes some general
information on the subject.

Reevaluation of aircraft' in service

Based upon information now at hand, later to be supplemented

by information derived from the contract work and from the
accident investigation, we are proceeding with a reexamination
of the basis for approval of lightning protective features of
a l l turbine-engined aircraft.

Through your Mr. Hallman's participation as a member of the Technical

Committee, we are receiving information on.ghe continuing work by your
investigators, and he is being regularly.informed of the status of
lightning program plans, actions,' and results. We believe that the
collective efforts being applied to this program will be successful in
producing practical ways and means for improved protec